Determinants of early dilated cardiomyopathy in neonates with congenital complete atrioventricular block

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Abstract

AimsDilated cardiomyopathy (DCM) can occur in infants with congenital complete atrioventricular block (CCAVB) treated by permanent pacemaker (PM), even without other congenital heart defects. The objective is to find the risk factors of this complication.Methods and resultsRetrospective analysis of a single-centre experience. Since 1992, 25 patients, aged 25 (1-355) days [median (range)], with normal ejection fraction (EF), underwent PM implantation (13 DDD, 12 VVIR) with an RV-pacing site. Follow-up was 4 (0.3-16) years. DCM occurred after 4 (3-23) months in eight patients (32). Univariate analysis identified the following risk factors: younger age at implantation [5 (1-85) days vs. 90 (1-355) P = 0.007], a broad QRS (50 vs. 18 P = 0.03), prolonged QTc at implantation (63 vs. 0, P = 0.001), and greater duration of heart rate >160 bpm during the first month after implantation (18 vs. 2, P = 0.03). By multivariate analysis prolonged QTc was the only significant risk factor for DCM (hazard ratio: 23, P <0.001, 95 confidence interval: 4-128). One patient died of heart failure, one was lost to follow up, and two were compensated on anticongestive therapy. EF normalized in four patients after resynchronization therapy (two patients), normalization of AV conduction or changing pacing mode to allow predominant narrow QRS junctional rhythm (one patient each).ConclusionsNeonates with CCAVB without other congenital heart defects and prolonged QTc are at high risk for DCM possibly due to electromechanical dyssynchrony induced by high-rate RV pacing. In patients in whom RV pacing was discontinued, EF became normal.

Original languageEnglish
Pages (from-to)1316-1321
Number of pages6
JournalEuropace
Volume12
Issue number9
DOIs
Publication statusPublished - Sep 2010

Fingerprint

Atrioventricular Block
Dilated Cardiomyopathy
Newborn Infant
Congenital Heart Defects
Dichlorodiphenyldichloroethane
Lost to Follow-Up
Cardiomyopathies
Reference Values
Multivariate Analysis
Heart Failure
Heart Rate
Confidence Intervals
Therapeutics

Keywords

  • Cardiac pacing
  • Children
  • Endocardial pacing
  • Epicardial pacing
  • Heart failure
  • Long QT
  • Pacing complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{189bcbfb76ee47db8c6e14cfe9d430f7,
title = "Determinants of early dilated cardiomyopathy in neonates with congenital complete atrioventricular block",
abstract = "AimsDilated cardiomyopathy (DCM) can occur in infants with congenital complete atrioventricular block (CCAVB) treated by permanent pacemaker (PM), even without other congenital heart defects. The objective is to find the risk factors of this complication.Methods and resultsRetrospective analysis of a single-centre experience. Since 1992, 25 patients, aged 25 (1-355) days [median (range)], with normal ejection fraction (EF), underwent PM implantation (13 DDD, 12 VVIR) with an RV-pacing site. Follow-up was 4 (0.3-16) years. DCM occurred after 4 (3-23) months in eight patients (32). Univariate analysis identified the following risk factors: younger age at implantation [5 (1-85) days vs. 90 (1-355) P = 0.007], a broad QRS (50 vs. 18 P = 0.03), prolonged QTc at implantation (63 vs. 0, P = 0.001), and greater duration of heart rate >160 bpm during the first month after implantation (18 vs. 2, P = 0.03). By multivariate analysis prolonged QTc was the only significant risk factor for DCM (hazard ratio: 23, P <0.001, 95 confidence interval: 4-128). One patient died of heart failure, one was lost to follow up, and two were compensated on anticongestive therapy. EF normalized in four patients after resynchronization therapy (two patients), normalization of AV conduction or changing pacing mode to allow predominant narrow QRS junctional rhythm (one patient each).ConclusionsNeonates with CCAVB without other congenital heart defects and prolonged QTc are at high risk for DCM possibly due to electromechanical dyssynchrony induced by high-rate RV pacing. In patients in whom RV pacing was discontinued, EF became normal.",
keywords = "Cardiac pacing, Children, Endocardial pacing, Epicardial pacing, Heart failure, Long QT, Pacing complications",
author = "Silvetti, {Massimo Stefano} and Fabrizio Drago and Lucilla Rav",
year = "2010",
month = "9",
doi = "10.1093/europace/euq258",
language = "English",
volume = "12",
pages = "1316--1321",
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T1 - Determinants of early dilated cardiomyopathy in neonates with congenital complete atrioventricular block

AU - Silvetti, Massimo Stefano

AU - Drago, Fabrizio

AU - Rav, Lucilla

PY - 2010/9

Y1 - 2010/9

N2 - AimsDilated cardiomyopathy (DCM) can occur in infants with congenital complete atrioventricular block (CCAVB) treated by permanent pacemaker (PM), even without other congenital heart defects. The objective is to find the risk factors of this complication.Methods and resultsRetrospective analysis of a single-centre experience. Since 1992, 25 patients, aged 25 (1-355) days [median (range)], with normal ejection fraction (EF), underwent PM implantation (13 DDD, 12 VVIR) with an RV-pacing site. Follow-up was 4 (0.3-16) years. DCM occurred after 4 (3-23) months in eight patients (32). Univariate analysis identified the following risk factors: younger age at implantation [5 (1-85) days vs. 90 (1-355) P = 0.007], a broad QRS (50 vs. 18 P = 0.03), prolonged QTc at implantation (63 vs. 0, P = 0.001), and greater duration of heart rate >160 bpm during the first month after implantation (18 vs. 2, P = 0.03). By multivariate analysis prolonged QTc was the only significant risk factor for DCM (hazard ratio: 23, P <0.001, 95 confidence interval: 4-128). One patient died of heart failure, one was lost to follow up, and two were compensated on anticongestive therapy. EF normalized in four patients after resynchronization therapy (two patients), normalization of AV conduction or changing pacing mode to allow predominant narrow QRS junctional rhythm (one patient each).ConclusionsNeonates with CCAVB without other congenital heart defects and prolonged QTc are at high risk for DCM possibly due to electromechanical dyssynchrony induced by high-rate RV pacing. In patients in whom RV pacing was discontinued, EF became normal.

AB - AimsDilated cardiomyopathy (DCM) can occur in infants with congenital complete atrioventricular block (CCAVB) treated by permanent pacemaker (PM), even without other congenital heart defects. The objective is to find the risk factors of this complication.Methods and resultsRetrospective analysis of a single-centre experience. Since 1992, 25 patients, aged 25 (1-355) days [median (range)], with normal ejection fraction (EF), underwent PM implantation (13 DDD, 12 VVIR) with an RV-pacing site. Follow-up was 4 (0.3-16) years. DCM occurred after 4 (3-23) months in eight patients (32). Univariate analysis identified the following risk factors: younger age at implantation [5 (1-85) days vs. 90 (1-355) P = 0.007], a broad QRS (50 vs. 18 P = 0.03), prolonged QTc at implantation (63 vs. 0, P = 0.001), and greater duration of heart rate >160 bpm during the first month after implantation (18 vs. 2, P = 0.03). By multivariate analysis prolonged QTc was the only significant risk factor for DCM (hazard ratio: 23, P <0.001, 95 confidence interval: 4-128). One patient died of heart failure, one was lost to follow up, and two were compensated on anticongestive therapy. EF normalized in four patients after resynchronization therapy (two patients), normalization of AV conduction or changing pacing mode to allow predominant narrow QRS junctional rhythm (one patient each).ConclusionsNeonates with CCAVB without other congenital heart defects and prolonged QTc are at high risk for DCM possibly due to electromechanical dyssynchrony induced by high-rate RV pacing. In patients in whom RV pacing was discontinued, EF became normal.

KW - Cardiac pacing

KW - Children

KW - Endocardial pacing

KW - Epicardial pacing

KW - Heart failure

KW - Long QT

KW - Pacing complications

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DO - 10.1093/europace/euq258

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